Clinical characteristics of patients with COVID-19 vaccine-related pneumonitis: a case series and literature review

Abstract

Background/Aims: Pulmonary toxicities of coronavirus disease 2019 (COVID-19) vaccination are exceedingly rare. However, there are a few reported cases after mRNA vaccination, especially from Asian countries. The purpose of this study was to report the clinical characteristics of patients with COVID-19 vaccine-related pneumonitis (CV-P) and to review cases reported in the literature. Methods: We performed a prospective, observational case series analysis. Results: Eleven patients with a median age of 80 years were enrolled. Ten patients developed CV-P after BNT162b2-mRNA vaccination and one after ChAdOx1 nCoV-19 vaccination. We identified various patterns of CV-P, including transient infiltration, life-threatening acute respiratory distress syndrome, and aggravation of underlying interstitial lung disease. Most patients showed favorable outcomes with good responses to corticosteroid therapy. Conclusions: Identifying the mechanism of CV-P requires further investigation; however, radiological and laboratory findings in our case series support inflammatory dysregulation in the lung parenchyma after vaccination. Clinicians should consider CV-P in patients with atypical lung infiltration, no specific etiologies, and recent COVID-19 vaccination.

Three Cases of Coronavirus Disease 2019 Vaccine-associated Organizing Pneumonia

“…The literature review revealed 27 cases of COVID-19 vaccine-associated pneumonia (CVP) 2–7 . CVP can occur either after the first, second, or subsequent vaccinations.…”

“…The literature review revealed 27 cases of COVID-19 vaccine-associated pneumonia (CVP). [2][3][4][5][6][7] CVP can occur either after the first, second, or subsequent vaccinations. The onset of symptoms with CVP ranges from the day of vaccination to 1 month after.…”

“…Chest CT patterns of CVP in the previous reports are various and include OP in 10 cases, DAD in 9 cases, nonspecific interstitial pneumonia in 3 cases, acute eosinophilic pneumonia (AEP) in 2 cases, and exacerbation of preexisting interstitial lung disease in 3 cases. [2][3][4][5][6][7] A variety of conditions that can present as OP or DAD patterns, such as infections, drugs, interstitial pneumonia, and vasculitis, are considered for differential diagnosis of CVP. Without the recognition of the close history of vaccination, the suspicion of CVP is difficult.…”

“…The safety and efficacy of these vaccines have been confirmed in clinical trials. 1 Recently, several cases of lung injuries have been reported after COVID-19 vaccination, [2][3][4][5][6][7] although the causal relationship has not been fully proven. In our hospital, the cross-reference review between the clinical records and radiologic reports system revealed 13 cases of lung injuries that were suspected to be caused by COVID-19 vaccination from March 2021 to March 2022.…”